WO2003071972A1

WO2003071972A1 - Method and device for placing dental implants

Info

Publication number: WO2003071972A1
Application number: PCT/FR2003/000667
Authority: WO
Inventors: Philippe Tardieu; Luc Vrielinck
Original assignee: Materialise Nv
Priority date: 2002-02-28
Filing date: 2003-02-28
Publication date: 2003-09-04
Also published as: FR2836372B1; EP1478298B1; AU2003229850A1; US20100009314A1; KR20040101247A; EP1478298A1; JP2005518834A; CA2477107C; CA2477107A1; KR100963365B1; FR2836372A1; US20110275032A1; JP4395375B2; US20050170311A1

Abstract

The invention relates to a method and device for placing implants (1) using a surgical template (11) which is made from tomographic cuts in the patient's jawbone (7). According to the invention, step drills (4) and calibrating drills (5), having a single standard diameter for each type of implant (1), are guided through drill bushings (18) which are inserted into bores (15) in the template (11) in order to produce any drilling sequence corresponding to an implant plan. The penetration depth of the drills (4, 5) is controlled by the height of the bores (15) or by the drill rings (21). The aforementioned template (11) bores (15) serve as a guide for the precise placement of the implants (1) owing to the adapted implant supports (3). Moreover, washers (23), which are mounted around the implant supports (3), limit compression in relation to the implants (1) while said implants are being placed (20). The above-mentioned characteristics serve to limit the required number of drills (4, 5) and implant supports (3) to the longest models only. The inventive method and device are particularly suitable for computer-assisted implantology systems.

Description

METHOD AND DEVICE FOR POSITIONING

DENTAL IMPLANTS

TECHNICAL FIELD OF THE INVENTION

The present invention relates to a method and a device for placing dental implants.

TECHNOLOGICAL BACKGROUND OF THE INVENTION

Aesthetic considerations or therapeutic indications often lead to replacing the missing teeth of the severely degraded teeth of a patient with prostheses. The most common prostheses are still dentures with dental or mucous support, while the installation of prostheses is anchored in the patient's mandible or maxilla by means of one or more implants screwed into holes drilled in the bone tissue.

Modern medical imaging techniques coupled with robotic techniques make it possible to simulate in three dimensions on a computer the placement of implants before any intervention, and to make a drilling template which will guide the dental surgeon during the operation. The implementation of these techniques has considerably increased the rate of obtaining good aesthetic results, while reducing the risk of post-operative complications. A method and a device of this type for determining the ideal location of an implant, and designed for the precise positioning thereof, are described in American patent US-5,320,529, in the name of D. Pompa , published on June 14, 1994. A stereolithographic model of the jaw bone is made from tomographic sections, and allows the practitioner to simulate the placement of prostheses on this model. A Surgical template is made by molding the bone model and radio-opaque models of the implants in place, fitted with their implant holders. Drill barrels with internal diameters corresponding to drills of different sizes are then placed in the impressions of the implant holders.

This process makes it possible to obtain a precise surgical template, but it does not fully use the possibilities and advantages of a computer simulation because this template is obtained by transferring the implant simulation by molding from a real model of the 'os, not from the virtual model.

The drilling template described in international application WO 99/26540, in the name of M. Klein et al., Published on June 3, 1999, takes up the previous principle of the use of drilling guns of different diameters inserted in boreholes of single diameter, with the difference that these are inserted into cylinders themselves placed in bores drilled directly in the scanner guide by a drill with digital control from the scanner data.

The constraint of an additional molding step is therefore eliminated by proceeding in this way.

However, the method and the system described in application WO 99/26540 only seem to apply to templates with dental support, to the exclusion of templates with bone or mucous support. In addition, the drilling barrels are held in place in the cylinders by a flange and a clamping screw, which constitutes a major drawback. In addition to the operational difficulties linked to the placement and adjustment of such a large number of elements in the patient's mouth, as well as to the instability of their fixation, this system of drilling guns of various diameters maintained by screws also compromises the safety of the intervention because ingestion of one of the parts is always possible. The views illustrating the publication (Practical Procedures & Aesthetic Dentistery, Vol. 13, No. 2, March 2001, pages 165-9, M. Klein et al.) Of the results obtained by the method and the device objects of the application WO 99/26540 clearly show the excessive bulkiness of the cylinder flange, and the difficulty in accessing the screw without tightening head, with hexagon socket, in the radial position. The process for manufacturing models of parts of the human body from digital images disclosed by the Materialized Company in Belgian patent BE-1,008,372, published on April 2, 1996, and applied in particular to computer-assisted implantology, leads to an additional simplification by allowing the manufacture by stereolithography, rapid prototyping technique well known in plastics, of models of mandibles, maxillae and surgical templates corresponding to any implant planning required.

The software derived from this patented process for the acquisition of scanner data, the computer simulation of the mandible or maxilla, the visualization of implant projects and the template, as well as the piloting of the prototyping machine, is marketed under the name of SurgiCase and offers the practitioner a commonly applicable solution.

From the scanner data, the implantologist prepares with the software a virtual implant planning and transmits the results to the service office responsible for converting his data into actual drilling templates. During operation, a template is positioned on the alveolar ridge; thanks to the complex shapes of the jaws and teeth, the position of the template is unique and stable. The templates contain implantable stainless steel cylinders which constitute physical guides for the drills during surgery and allow optimal control of the drilling axes. Several templates are manufactured with cylinders of different diameters allowing to take into account the drilling sequence specific to each implant, and to adapt well to each particular case. When the site is ready, the implants are inserted in the usual way by means of implant holders. However, the obligation to use several templates somewhat reduces the interest of the simplification obtained by implementing the process of the Materialized Company.

It therefore appears from the documents cited above that various methods and devices for placing dental implants are known from the state of the art; however, these methods and devices do not entirely satisfy the practitioner, who is still hampered by too many constraints in their use.

GENERAL DESCRIPTION OF THE INVENTION

The present invention therefore relates to a method and a device for placing dental implants intended to eliminate the constraints of use of the methods and systems of the prior art.

Its specific object is a method of the type comprising the following steps: a) setting up of a scanning guide in the patient's mouth, b) computer acquisition of the scanning guide data, and of the mandible or maxilla of the patient, c) computer simulation of the mandible or maxilla from scanner data, d) generation by computer, under the practitioner's control, of implant planning parameters from this simulation, e) computer control from planning parameters of a device for forming a template having pre-calculated axis and position bores, f) fixing in these bores of guide cylinders of a single standard dimension predetermined according to the type of implants , g) insertion into the guide cylinders of barrels arranged so as to control the direction and depth of penetration of drills, h) drilling by means of the drills used successively and through the drilling barrels with holes in the mandible, or the maxilla , intended to receive the implants, and i) placement through the implant guide cylinders in the holes by means of implant holders.

The method for placing dental implants according to the invention consists in:.

- pre-manufacture the drill barrels in a single standard internal diameter predetermined according to the type of implants,

- produce beforehand a first set of drills consisting of stepped drills whose standard maximum diameter corresponds to the internal diameter of the drilling barrels,

- produce beforehand a second set of drills made up of calibrating drills whose standard nominal diameter corresponds to the inside diameter of the barrels, in order to carry out the drilling sequence specific to each implant using only one of the drills for each of the holes first stages, then one of the sizing drills, instead of having to use successively several drills and barrels of increasing diameters.

The method according to the invention is also advantageous because the placement of the implants is guided by specific implant holders sliding in the cylinders of the template.

The method for placing dental implants according to the invention is also remarkable in that the implant planning parameters include the heights of the bores, calculated by computer or determined by the practitioner, in order to control the depth without additional means. penetration of the drills into the patient's maxilla or mandible.

Alternatively or simultaneously, according to a variant of the method for placing dental implants according to 1 invention, a set of inner diameter rings corresponding to the diameter of the drills is produced beforehand. A first intermediate stage of the process then consists in engaging, or not, as required, at least one of the rings on the drills in order to control the depth of penetration into the mandible or the maxilla of the patient.

The drilling operation then takes advantage of these last two particular characteristics of the process by using only stage drills and calibrating drills of a single standard length predetermined according to the type of implants, whatever the depth of the osteotomies to achieve.

The method according to the invention also benefits from the prior production of a set of washers with an internal diameter corresponding to the diameter of the implant holders. When necessary, during a second intermediate stage, the engagement of at least one of these washers on the implant holders makes it possible to control the penetration depth of the implants. In the latter case, the placement operation advantageously uses implant holders of a single standard length predetermined according to the type of implants, regardless of the height of the implants to be placed.

An additional feature of the process is that the insertion of the barrels into the guide cylinders is preferably carried out by screwing. Similarly, the fixing of these cylinders in the template is preferably carried out by gluing.

The method for placing dental implants according to the invention is advantageously implemented by a device of the type of those comprising: a) a scanning guide intended to be placed in the mouth of the patient, b) a first system of acquisition of scanner guide data on the computer, and of the mandible or maxilla of this patient, c) a second computer simulation system of the mandible or maxilla from scanner data, d) a third computer-generated generation of implant planning parameters from this simulation, e) a fourth training system a computer-controlled drilling jig, f) a fifth computerized piloting system for this fourth system from planning parameters, g) bores in the jig of axes and precalculated positions, and provided with guiding guide cylinders standard size predetermined as a function of the type of implants, h) drill barrels arranged coaxially in the upper part of the guide cylinders, i) drills with diameters corresponding to the internal diameters of the barrels, and j) implant holders.

The essential characteristic of the device according to the invention is that the drilling barrels all have a single standard internal diameter predetermined according to the type of the implants, and that the drills present a first set of stepped drills and a second set of calibrating drills, of which, respectively, the maximum standard diameter and the standard nominal diameter correspond to the internal diameter of these barrels.

Advantageously, each of the stepped drills has successively along its axis, from the pointed end to the other end:

- a first drilling length of a single standard diameter predetermined according to the type of implants,

- a second drilling length, adjacent to the first, of a single standard diameter predetermined according to the type of implants and greater than the diameter of the first drilling length, - a smooth part of a single standard diameter predetermined according to the type of implants and corresponding to the standard internal diameter of the drilling barrels, - a collar, and

- a standard locking means for handpiece.

Also advantageously, each of the calibrating drills has successively along its axis, from the pointed end to the other end:

a first cutting length of a single standard diameter predetermined as a function of the type of the implants and corresponding to the standard internal diameter of the drilling barrels, a second cutting length of diameter substantially less than the diameter of the first cutting length,

- a smooth zone with a single standard diameter predetermined as a function of the type of implants and corresponding to the single internal diameter of the barrels, - a flange, and

- a standard locking means for handpiece.

One benefits from implant holders according to the invention each consisting, on the one hand, of a mandrel having successively along the axis:

- an additional part of an instrument holder,

- a collar,

a smooth sleeve with a single standard outside diameter predetermined as a function of the type of implants and corresponding to the standard inside diameter of the guide cylinders, and

- a shape complementary to the standard head of the implants, and, on the other hand, a screw passing through the mandrel and screwed into the implant head. An additional feature of the device for placing dental implants according to the invention is that the holes in the template are of variable heights in order to limit the depth of penetration of the drills into the patient's mandible or maxilla without additional means. of the operation.

Alternatively or simultaneously, the device for placing dental implants according to the invention comprises moreover, a set of rings of internal diameter corresponding to the diameter of the drills, these rings being intended to be inserted around the smooth part or of the smooth zone of each of the drills in order to control the depth of penetration.

In the latter two cases, the stepped drills and the calibrating drills of the device for the placement of dental implants according to the invention are all of a single standard length predetermined according to the type of implants, whatever the depth of the holes to be made, thus constituting "universal" drills.

Advantageously, the device for placing dental implants according to the invention further comprises a set of washers with an internal diameter corresponding to the diameter of the implant holders, the washers being intended to be inserted around the smooth sleeve of each of the holders. - implants in order to control the penetration depth of the implant.

Implant holders of a single standard length predetermined according to the type of implants, thus constituting “universal” implant holders, benefit from this latter arrangement.

Preferably, the cylinders and the drilling barrels of the device according to the invention respectively comprise an internal thread and an external thread having four helices at 90 ° from one another.

Very advantageously, each of the barrels of this device has a ring comprising a tangential light. Alternatively or simultaneously, this ring has four radial blind holes at 90 ° from one another.

According to an additional characteristic of the device for the placement of dental implants which is the subject of the present application, the rings and the washers intended respectively to be inserted around either the drills or the implant holders are made of bio-compatible plastic material, preferably poly-oxy-methacrylate (POM). Advantageously, the guide cylinders in the template are for their part made of titanium alloy, preferably TA6V, as well as the mandrels of the implant holders, while the barrels are made of steel, preferably of STAINLESS STEEL 316L.

These few essential specifications make it obvious to a person skilled in the art the advantages provided by the method and the device for placing dental implants according to the invention compared with the state of the prior art. The detailed specifications of the invention, and in particular examples of advantageous selections of dimensional characteristics of the device, are given in the description which follows in conjunction with the attached drawings. It should be noted that these drawings have no other purpose than to illustrate the text of the description and do not in any way constitute a limitation of the scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1 is a block diagram of the succession of steps involved in the implantation methods of dental implants known from the prior art to which the present invention relates.

Figure 2 is an exploded view of part of the device according to the invention during the drilling step, showing in particular the drilling template, the guides and a step drill and its ring. Figures 3a and 3b are respectively a sectional view

(according to A-A) and a top view of a template guide cylinder.

Figures 4a and 4b are respectively a front view and a top view of a drilling gun of the template. Figures 5a and 5b are respectively a sectional view

(according to BB) and a top view of a drill ring used to limit the depth of penetration. Figures 6 and 7 are respectively a front view of a floor drill and a calibrator drill.

Figure 8 is an exploded view of part of the device according to the invention during the implant placement step, showing in particular the drilling template, an implant, a washer, an implant holder, and its screw.

Figures 9a and 9b are respectively a front view and a top view of an implant holder according to the invention.

Figure 10 is a front view of the corresponding implant holder screw.

DESCRIPTION OF THE PREFERRED FORMS OF THE INVENTION

Figure 1 schematically shows the sequence known per se of the various operations leading to the establishment of dental implants 1 in the mouth of a patient.

In a preliminary step 2, the practitioner having at his disposal a computer-assisted implantology system decides with the patient on the placement of implants 1. This system is a complex set of processes and materials optimized according to the purpose to reach. It follows that the characteristics of each of the elements of this system are strongly interdependent, and lead to standards of facts, results of the generalization of certain "proprietary systems" marketed by the most important manufacturers of medical devices. The implantologist must therefore have at the start of the equipment (implants 1, implant holders 3, drills 4,5, etc.) adapted to the rest of the system that he proposes to implement. It goes without saying that the benefit of the patient and the practitioner is that the system used is as simple and as reliable as possible.

A scan guide is placed (step 6) in the patient's mouth, then the patient passes his scanner in the usual way. Such a scanning guide includes radio-opaque markers which will subsequently make it possible, according to known methods, to make the reference mark coincide radiological images acquired on a computer during this step 8 with the marks of the actual prostheses.

At the end of this examination, the scanner data of the patient's guide and jaw 7 are sent to a service office, which converts the raw data and prepares them before transmitting them to the implantologist.

The software available to the practitioner performs a virtual reconstruction of the mandible 7 or the maxilla of his patient from the prepared scanner data. This computer simulation 9 makes it possible to create an implant plan 10 by visualizing the locations of the future implants 1. The parameters of the plan 10 will be transmitted to the service office for the manufacture 12 of the drilling template 11. In a manner known per se, the service desk uses the data received during this manufacturing phase 12 to control a stereolithography device, which device has the advantage over the digital milling machine of being able to manufacture parts comprising closed cavities. The service office sticks (step 13) of the guide cylinders 14 inside the bores 15 of the template 11 and dispatches the latter, as well as a real model of the jaw 7, to the implantologist. These cylinders 14 are of a standard size, chosen according to the type of implants 1 which will be placed.

During the next step 16, that is to say during the surgical operation of placing the implants 1 in itself, the practitioner uses the template 11 to drill the holes 17 intended to receive the implants 1, each at the point wanted and in the right direction as planned in planning 10.

In order to limit the heating of the bone tissue 7, a hole of small diameter is first drilled before going to a larger diameter to reach the nominal diameter. Conventionally, five drills are used to prepare the implantation site. The guide cylinders 14 of the template 11 having a given diameter, several templates 11 are therefore generally necessary to carry out a drilling sequence, at less use of a series of adaptation cannons 18 inserted in the cylinders 14.

This last way of doing things is retained in the method according to the invention, but, unlike the prior art, in this step 16, the drilling barrels 18 are only of one kind, with a predetermined internal diameter in depending on the type of implant 1. The manipulation of several barrels 18 for each borehole is therefore eliminated: the same standard barrel 18 is screwed into the cylinder 14 for the entire duration of the borehole. This is made possible thanks to the use, during the drilling phase 19, of only two drills 4.5, of a particular type: a drill called "stage drill" 4, then a drill called "calibrator drill" 5. All of these elements will be described in detail in connection with FIGS. 2, 3, 4, 6, and 7. The process of placing the implant 1 ends with the introduction of the latter by means of 'an implant holder 3 in the osteotomy 17 previously performed. During this final step 20, the implant 1 is correctly directed by a particular type of implant holder 3, specific to the method according to the invention, which is guided by sliding in the cylinder 14 of the template 11.

The drilling jigs 11 used normally have bores 17 of the same predetermined height when ordered by the practitioner as a function of the type of implants 1 that he will be called upon to use (“Standard”, “Wide”, or “Zygomatic "). Each type of implant 1. exists in several lengths. To drill cavities 17 of corresponding depths, it is therefore necessary to change the drill 4.5.

The method according to the invention proposes to keep only the 4.5 longest drills ("universal" drills for the type of implants 1 considered) and to adapt their lengths using rings 21 of known thickness. These rings limit the depth of penetration of the drill 4.5 into the bone 7 by filling more or less the free space between the top of the template 11 placed on the bone ridge and an axial stop 22 with which all the drills 4 are provided, 5. The same principle is applied to the implant holders 3: washers 23 inserted around the rod 24 serve to limit the screwing depth of the implant 1. In this way, the diversity of the lengths of the implant holders 3 is limited to the the only combination of implant types 1 and “bone” or “mucous” types of implant holders 3.

In a variant of the method, to avoid the use of rings 21, the practitioner specifies during manufacturing the heights of the holes 15 of the template 11. In this process, it is then the height of the stereolithographic tube 17 which changes and not not the drill 4.5. The deeper the stereolithographic tube 17, the deeper the drilling, using the same guide cylinders 14 and drill barrels 18. This process has three advantages: first of all, using only one length of drill 4, 5 for all depths; then not having to control the depths at each drilling, since this is pre-established by the template 11; finally, in the case of templates 11 with mucous support, this makes it possible to take account of the thickness of the mucosa which is uneven depending on the implant areas, without making any calculation or any adaptation.

All the elements of a computer-assisted implantology system suitable for implementing the method which has been explained in detail above will not be repeated here in detail. Only the parts of the device specific to the invention will be described below.

Figure 2 clearly shows the drilling template 11 wedged on the bony crest of a mandible 7, with the guide cylinders 14 in place in the bores 15. This situation corresponds to the time of phase 16 when the practitioner has already screwed the drilling barrels 18 in the cylinders 14 (the barrel 18 is here drawn above the cylinder 14 for clarity of the representation), and engages the drilling operational phase 19.

The “universal” stage drill 4 is provided with a ring 21 if the height of the bores 15 is not sufficient to limit its penetration to a depth corresponding to the size of the implant 1. The detailed characteristics of all the elements of Figure 2 are shown in Figures 3 to 7.

The guide cylinder 14 seen in section in Figure 3a, and from above in Figure 3b, has a threaded upper portion 25 extending over half its height. The thread has four hollow propellers offset by 90 °, which facilitates screwing and unscrewing.

The cylinder 14 has a height of 4 mm. It has an internal diameter, at tolerance H7, of 4.20 mm at the level of the unthreaded part. Its outside diameter is 5.20 mm. These dimensions are suitable for implants 1 of the “standard” type, having an external diameter of 3.75 mm or 4.00 mm, that is to say in 97% of the cases. Cylinders 14 of different dimensions exist for implants 1 of the “Wide” type, of 4.75 mm, 5 mm or 6 mm in diameter.

The cylinders 14 are made of implantable metal, preferably of TAV6 titanium alloy.

The drill barrel 18, seen from the front in FIG. 4a and from above in FIG. 4b, has an external screw pitch 26 which is close to the upper end and is complementary to the threaded part 25 of the cylinder 14. The four offset propellers allow to engage the barrel 18 in its cylinder in only a quarter turn.

The manipulation and clamping / loosening of the barrel 18 by means of a tool is made easier thanks to a ring 27 surrounding its upper end, and having four radial blind holes 28. A tangential cylindrical light 29 makes it possible to pass a silk thread serving as a "parachute".

The drilling barrel 18 has a height of 5 mm and, apart from the threading, its outside diameter is 4.20 mm at the tolerance g6, that is to say corresponding to the inside diameter of the cylinder 14, and suitable for most common cases. The outer diameter of the ring 27 is 5.2 mm and its height is 0.5 mm. The internal diameter of the barrel 18 is 3.20 mm to guide 4.5 drills of 3.15 mm in diameter.

The drilling barrels 18 are made of steel, preferably stainless steel 316L. The ring shown in Figures 5a and 5b does not have any particular characteristic other than dimensions adapted to the system. Its outside diameter is the diameter common to the ring 27 of the drilling barrel 18 and to the flange 22 of the drills 4.5 between which it is placed, that is 5.2 mm.

Its internal diameter of 3.10 mm is slightly smaller than the diameter of 3.15 mm of the 4.5 drills so that it adheres to them.

These rings 21 are made of poly-oxy-methacrylate

(POM). Rings 21 with a thickness of 0.5 mm are preferably made of natural POM of white color, while rings 21 with a thickness of 1.5 mm are preferably colored in black, in order to be more easily distinguished one another.

The stage drill 4 shown in Figure 6 allows the ball mill, the 2 mm drill and the pilot drill to be replaced by a single drill.

A stage 4 drill for an implant 1 10 mm long, but representative of the system in the case of standard implants 1, typically has: - a conical part with an opening angle of 120 ° followed by a first length drilling 30 2 mm in diameter and measuring 4 mm,

- a second drilling length 31 of 3 mm in diameter and measuring 6 mm, including the conical connection, with an opening angle of 120 °, with the first drilling length 30,

- a smooth part 32 of 3.15 mm in diameter and 5 mm long, including the conical connector, with a half-angle of opening of 10 °, with the second drilling length 31, - a flange 22 5.2 mm in diameter and 0.5 mm thick, and

- a standard locking means for handpiece 33 with a total length of 14 mm.

Stage 4 drills for implant lengths of 13, 15 or 18 mm also exist, but, as already explained, the longest drill in the series acts as a drill "Universal" used with POM rings 21 or with a template 11 having bores 15 of variable heights.

The calibrator drill 5 shown in FIG. 7 has an upper part 22, 33 identical to that of the stage drill 4.

In the case of a standard implant 1 with a length of 10 mm, the lower part of this drill 5 typically has:

- a conical part with an opening angle of 120 ° followed by a first cutting length 34 of 3.15 mm in diameter and measuring 4 mm,

- a second cutting length 35 of 3.00 mm in diameter and measuring 6 mm,

- a smooth zone 36 of 3.15 mm in diameter and 5 mm long, including the conical connection to the second cutting length 35 with a half opening angle of 10 °.

The stage drills 4 as well as the calibrator drills 5 are made of stainless steel, preferably of the Z33C13 type. Figure 8 shows an implant 1, an implant holder 3 and the template 11 during the placement step 20 of the implants 1 following the drilling step 19 (the elements have been separated here for the clarity of the representation) . The cavities 17 drilled in the bone tissue 7 at the exact location provided by the implant planning 10 will accommodate the implants 1. The guide cylinders 14 of the template 11, whose drill barrels 18 have been unscrewed, make it possible to precisely guide the implants 1 thanks to specific implant holders 3. Each of these implant holders 3 according to the invention comprises on the one hand a set of composite shape forming a mandrel 37 and on the other hand a fixing screw 38 of the implant 1. These two elements are shown respectively in the Figures 9 and 10. The mandrel 37 has an upper part 39 of hexagonal section forming a complementary part of an instrument holder. This part 39 has an axial bore 40 and is connected to a smooth sleeve 24 by a flange 22 identical to that of the drills 4,5. The base of the mandrel 37 comprises a cavity 41 of hexagonal section complementary to the hexagonal head 42, provided with a threaded blind hole, with an implant 1. The screw 38 passing through the mandrel 37 is screwed by means of its threaded end 43 in the hexagonal head 42 in order to make the implant 1 integral with the implant holder 3. To do this, the head of the screw 38 of the implant holder 3 is advantageously of the type of those with hexagon socket 44. The outside diameter of the sleeve 24 of the mandrel 37 corresponds to the inside diameter of a guide cylinder 14. In this way, the implant 1 is guided during its positioning by the sliding of the sleeve 24 in the cylinder 14 of the template 11. The flange 22 arriving in abutment on the upper part of the cylinder 14 limits the depression to the level desired by the surgeon. As already explained, POM washers 23 make it possible to precisely control this level of penetration.

Implant holders 3 are divided into two main types according to their length: bone implant holders, short, and long implant holders, suitable for transmucosal placement.

For standard implants 1, the outside diameter of the sleeve 24 of an implant holder 3 is 4.15 mm, which provides gentle sliding in a cylinder 14 having an inside diameter of 4.20 mm. The height of the sleeve 24 (height of the implant holder under the collar) is 4.5 mm for the bone implant holders, and 10.5 mm for the mucosal implant holders. The total length of the screw 38 of the implant holder 3 is 13.5 mm and 19.5 mm respectively. In the case of the “universal” bone implant holder and the “universal” mucosal implant holder, the sleeve 24 is 10.0 mm and 15.0 mm high, respectively, and the screw 38 is 19.0 mm and 24 respectively. , 0 mm long. The hexagon socket 41 of the base of the mandrel 24 and the M2 thread 43 of the screw 38 are compatible with most of the implants 1 on the market. The washers 23 of the implant holders 3 are made of the same bio-compatible plastic material as the rings 21 of the drills 4.5. In the case of standard implants, their outside diameter is that of the flanges 22, and their inside diameter is 4.10 mm, a diameter slightly smaller than the outside diameter of the sleeve 24. Their thickness is either 0.5 mm or 1, 5 mm. Preferably, the thinnest are white and the thickest are black so as not to be confused.

All of these characteristics provide the method and the device for placing dental implants according to the invention with several significant advantages compared with the prior art:

- only two drills are used (per type of implant) instead of several drills of different lengths and different diameters,

- the specific template allows drilling without calculation and without adjustment to the correct depth,

- only one drill barrel model is necessary (per type of implant) instead of a series of barrels with an increasing internal diameter,

- the handling of the barrels is facilitated because their specific mechanical design allows their engagement in the guide cylinders by simple screwing in a quarter turn, - safety is increased because the barrels have a "parachute", and

- the implant holders are precisely guided during the placement of the implant.

The method and the device described above can still be simplified in certain cases so as to no longer use a ring 21 and / or washer 23 to adapt the penetration lengths of the drills 4, 5 and, respectively, those of the holders. - implants 3, whatever the depth of drilling, the thickness of the gum or the level of penetration of the implants.

We know that the most frequently used drills have lengths 10, 13, 15, 18 and 20 mm. In addition, the most frequently used implant lengths are: 8.5; 10; 11.5; 13; 15; 18 and 20 mm.

Knowing that X is equal to the length of the drill used or usable minus the length of the implant to be placed, X must allow the use of an available implant holder, without ring or washer, by choosing X + 4 for length of the implant holder.

Whenever possible, a value of X will therefore be chosen such that it can meet the two aforementioned preconditions by retaining a drill of a specific length and an implant holder of an equally specific length.

Thus, this X value will be independent of the implantation of the implant in the bone and of its position relative to the bone crest, but also independent of the operating mode.

(bone guide or mucous guide), independent of the measurement of the thickness of the gum and independent of the determination of the surface of the crest of the bone. In most cases, it will thus be possible to drill and then place an implant without having to use either ring 21 or washer 23, or having to use a ring, but no washer, or a washer, but no 'ring.

Implant holder lengths of 4, 5, 6, 7, 9, 10, 11, 12, 13, 14 and 17 mm will in practice make it possible to respond to all of the aforementioned cases, that is to say d '' avoid the use of a ring and / or the use of a washer.

It goes without saying that the invention is not limited to the preferential embodiments described above. On the contrary, it embraces all possible variant embodiments which would not depart from the scope of the present invention as defined by the claims below.

Claims

1) Method for placing dental implants (1), of the type comprising the following steps: a) placing (6) a scan guide in the patient's mouth, b) acquisition (8) by computer of the scanner data of said guide, and of the mandible or maxilla (7) of said patient, c) simulation (9) on computer of said mandible or of said maxilla (7) from said data, d) generation (10) by computer under the control of the practitioner of implant planning parameters from said simulation (9), e) piloting (12) by computer from said parameters of a device for forming a template (11) having bores (15 ) of pre-calculated axes and positions, f) fixing (13) in said bores (15) of guide cylinders (14) of a single standard dimension predetermined according to the type of said implants (1), g) insertion (16) in said cylinders (14) of drill barrels (18) arranged so controlling the direction and depth of penetration of drills (4,5), h) drilling (19) through said barrels (18) of holes (17) intended to receive said implants (1) in said mandible or said maxilla (7 ) by means of said drills (4,5) used successively, i) placement (20) through said cylinders (14) by means of implant holders (3) of said implants (1) in said holes (17), said method being characterized in that:

the barrels (18) are produced beforehand (2) in a single standard internal diameter predetermined as a function of the type of said implants (1),

a first set of said drills (4,5) ^′ is produced beforehand (2) consisting of stepped drills (4) whose standard maximum diameter corresponds to the inside diameter of said barrels (18), - It is produced beforehand (2) a second set of said drills (4,5) consisting of calibrating drills (5) whose standard nominal diameter corresponds to the internal diameter of said barrels (18), - drilling (19) consists in using for each of said holes (17) first one of said stage drills (4), then one of said calibrator drills (5).

2) A method for placing dental implants (1) according to claim 1, characterized in that said placement (20) is guided by the implant holders (3) sliding in said cylinders (14).

3) Method for placing dental implants (1) according to any one of the preceding claims, characterized in that said parameters include the heights of said bores (15) in order to control the penetration depth of the drills without additional means ( 4,5) in the maxilla or in the mandible (7).

4) Method for the establishment of dental implants (1) according to any one of the preceding claims, characterized in that a set of rings (21) of internal diameter corresponding to the diameter of the drills (4,5) is previously produced (2) and in that said method comprises a first intermediate step consisting in the engagement of at least one of said rings (21) on said drills (4,5) in order to control the depth of penetration.

5) A method for placing dental implants (1) according to any one of the preceding claims 3 or 4 characterized in that the drilling (19) consists in using stage drills (4) and calibrating drills (5 ) of a single standard length predetermined as a function of the type of said implants (1), whatever the depth of the holes (17) to be produced. 6) Method for placing dental implants (1) according to any one of the preceding claims, characterized in that a set of washers (23) of internal diameter corresponding to the diameter of the implant holders (3) is produced beforehand (2) and in that said method comprises a second intermediate step consisting in engaging at least one of said washers (23) on said implant holders (3) in order to control the depth of penetration.

7) Method for the establishment of dental implants (1) according to claim 6 characterized in that the placement (20) consists in using implant holders (3) of a single standard length predetermined according to the type d implants (1), whatever the height of said implants (1) to be put in place.

8) A method for placing dental implants (1) according to any one of the preceding claims, characterized in that the insertion (16) is carried out by screwing.

9) Method for placing dental implants (1) according to any one of the preceding claims, characterized in that the fixing (13) is carried out by gluing.

10) Device for the establishment of dental implants (1) adapted to the implementation of the method according to any one of the preceding claims 1 to 9, of the type of those comprising: a) a scan guide intended to be placed in the patient's mouth, b) a first computer acquisition system of the scanner data of said guide, and of the mandible or maxilla (7) of said patient, c) a second computer simulation system of said mandible or said maxilla (7) from said data. d) a third system for generating computerized implant planning parameters from said simulation, e) a fourth system for forming a drilling gauge (11) which can be controlled by computer, f) a fifth system for controlling by computer using from said parameters of said fourth system, g) bores (15) in said template (11) of axes and pre-calculated positions provided with guide cylinders (14) of standard size predetermined according to the type of said implants (1) , h) drill barrels (18) arranged coaxially in the upper part (15) of said cylinders (14), i) drills (4,5) of diameters corresponding to the internal diameters of said barrels (18), and j) implant holders (3). characterized in that said barrels (18) all have a single standard internal diameter predetermined as a function of the type of said implants (1) and in that said drills (4,5) have a first set of stepped drills (4) and a second set of calibrating drills (5) of which, respectively, the maximum standard diameter and the standard nominal diameter correspond to the internal diameter of said barrels (18).

11) Device for placing dental implants (1) according to claim 10, characterized in that each of the stepped drills (4) has successively, along its axis, from the pointed end to the other end: - a first drilling length (30) of a single standard diameter predetermined as a function of the type of said implants

(D, a second drilling length (31), adjacent to said first drilling length (30), of a single standard diameter predetermined according to the type of said implants (1) and greater than the diameter of said first drilling length (30) , a smooth part (32) of a single standard diameter predetermined as a function of the type of said implants (1) and corresponding to the standard internal diameter of said barrels (18), - a flange (22), and

- a standard locking means for handpiece (33).

12) Device for the establishment of dental implants (1) according to any one of claims 10 or 11 above, characterized in that each of the calibrating drills (5) has successively along its axis, from the pointed end to the other extremity :

a first cutting length (34) of a single standard diameter predetermined as a function of the type of said implants (1) and corresponding to the standard internal diameter of said barrels (18),

- a second cutting length (35) of diameter substantially smaller than the diameter of said first cutting length (34), - a smooth zone (36) of a single standard diameter predetermined according to the type of said implants (1) and corresponding the single internal diameter of said barrels (18),

- a flange (22), and - a standard locking means for handpiece (33).

13) Device for placing dental implants (1) according to any one of the preceding claims 10 to 12, characterized in that each of the implant holders (3) consists, on the one hand, of a mandrel (37) having successively along its axis:

- a part (39) complementary to an instrument holder,

- a collar (22),

a smooth sleeve (24) with a single standard outside diameter predetermined as a function of the type of said implants (1) and corresponding to the standard inside diameter of said cylinders (14), - A shape (41) complementary to the standard head (42) of said implants (1), and, on the other hand, of a screw (38) passing through said mandrel (37) and screwed into said head (42).

14) Device for placing dental implants (1) according to any one of the preceding claims 10 to 13, characterized in that the bores (15) are of variable heights in order to limit the depth of penetration without additional means drills (4,5) in the mandible or maxilla (7).

15) Device for the establishment of dental implants (1) according to any one of claims 11 or 12 preceding, characterized in that it further comprises a set of rings (21) of internal diameter corresponding to the diameter drills (4,5), said rings (21) being intended to be inserted around the smooth part (32) or the smooth zone (36) of each of the drills (4,5) in order to control the depth of penetration .

16) Device for the establishment of dental implants (1) according to any one of claims 14 or 15 preceding, characterized in that the stage drills (4) and the calibrator drills (5) are all in one standard length predetermined as a function of the type of said implants (1), whatever the depth of the holes (17) to be produced, thus constituting "universal" drills.

17) Device for placing dental implants (1) according to claim 13, characterized in that it further comprises a set of washers (23) of internal diameter corresponding to the diameter of the implant holders (3), said washers (23) being intended to be inserted around the smooth sleeve (24) of each of said implant holders (3) in order to control the depth of penetration. 18) Device for placing dental implants (1) according to claim 17, characterized in that the implant holders (3) are all of a single standard length predetermined according to the type of said implants (1), whatever the height of said implants (1) to be placed, thus constituting "universal" implant holders.

19) Device for placing dental implants (1) according to any one of the preceding claims 10 to 18, characterized in that the cylinders (14) and the barrels (18) respectively comprise an internal thread (25) and an external thread (26) having four helices at 90 ° from each other.

20) Device for placing dental implants (1) according to any one of the preceding claims 10 to 19, characterized in that each of the barrels (18) has a ring (27) comprising a tangential lumen (29) .

21) Device for placing dental implants (1) according to any one of the preceding claims 10 to 20, characterized in that each of the barrels (18) has a ring (27) comprising four blind holes (28) radial at 90 ° to each other.

22) Device for placing dental implants (1) according to any one of the preceding claims 15 or 17, characterized in that the rings (21) and the washers (23) are made of bio-compatible plastic, preferably poly-oxy-methacrylate (POM).

23) Device for the placement of dental implants according to any one of the preceding claims 10 to 22, characterized in that the cylinders (14) are made of titanium alloy, preferably TA6V. 24) Device for the establishment of dental implants (1) according to any one of the preceding claims 10 to 23, characterized in that the barrels (18) are made of steel, preferably made of 316L stainless steel.

25) Device for placing dental implants (1) according to claim 13 or any one of the preceding claims 14 to 24 dependent on claim 13, characterized in that the mandrel (37) is made of titanium alloy , preferably TA6V.

26) Device for placing dental implants (1) according to any one of the preceding claims 10 to 25, characterized in that the standard internal diameter of the barrels (18) is preferably 3.20 mm, the diameter corresponding maximum standard of the stage drills (4) and the corresponding standard nominal diameter of the calibrating drills (5) preferably being 3.15 mm.

27) Device for placing dental implants (1) according to claim 13 and any one of the preceding claims 14 to 26 dependent on claim 13, characterized in that the standard internal diameter of the cylinders (14) is preferably 4.20 mm and the corresponding standard outside diameter of the sleeve (24) is preferably 4.15 mm.

28) Device for placing dental implants (1) according to claims 11 or 12 and any one of the preceding claims 13 to 27 dependent on claim 11 or 12, characterized in that the drilling lengths (30 , 31) or the cutting lengths (34,35) preferably extend over 10 mm, 13 mm, 15 mm, or 18 mm in the case of "universal" drills.

29) Device for placing dental implants (1) according to claim 11 and any one of preceding claims 12 to 28 dependent on claim 11, characterized in that:

the first drilling length (30) preferably has a diameter of 2 mm and extends over 4 mm, the second drilling length (31) preferably has a diameter of 3 mm and extends over 6 mm,

- The smooth part (32) preferably has a diameter of 3.15 mm and extends over 5 mm.

30) Device for placing dental implants (1) according to claim 12 and any one of the preceding claims 13 to 29 dependent on claim 12, characterized in that:

the cutting length (34) preferably has a diameter of 3.15 mm and extends over 4 mm,

the second cutting length (35) preferably has a diameter of 3 mm and extends over 6mm,

- The smooth zone (36) preferably has a diameter of 3.15 mm and extends over 5 mm.

31) Device for placing dental implants (1) according to claim 13 and any one of the preceding claims 14 to 30 dependent on claim 13, characterized in that the length of the sleeve (24) and the length of the screw (38) are preferably, respectively, 4.5 mm and 13.5 mm in the case of a bone implant holder, 10.5 mm and 19.5 mm in the case of a holder mucous implant, 10.0 mm and 19.0 mm in the case of one of said bone “universal” implant holders, and 15.0 mm and 24.0 mm in the case of one of said “universal” implant holders »Mucous.

32) Device for placing dental implants (1) according to claims 11, 12 or 13 and any one of the preceding claims 14 to 31 dependent on claims 11, 12 or 13, characterized in that the flange ( 22) preferably has a thickness of 0.5 mm and an outside diameter of 5.2 mm. 33) Device for placing dental implants (1) according to claim 15 and any one of the preceding claims 16 to 32 dependent on claim 15, characterized in that the internal diameter of the rings (21) is preferably 3.10 mm, their outside diameter is preferably 5.2 mm, and their thickness is preferably 0.5 mm or 1.5 mm.

34) Device for placing dental implants (1) according to claim 17 and any one of the preceding claims 18 to 33 dependent on claim 16, characterized in that the internal diameter of the washers (23) is preferably 4.10 mm, their outside diameter is preferably 5.2 mm, and their thickness is preferably 0.5 mm or 1.5 mm.